Provider Demographics
NPI:1467697409
Name:ROBINSON, SUSAN T (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:T
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CRESTHILL DR
Mailing Address - Street 2:#A
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-2725
Mailing Address - Country:US
Mailing Address - Phone:415-846-9330
Mailing Address - Fax:
Practice Address - Street 1:101 GRACELAND DRIVE
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901
Practice Address - Country:US
Practice Address - Phone:415-457-1696
Practice Address - Fax:415-457-1696
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-04
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS16418104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker